FA-700 - Missouri Department of Social Services



|[pic] |MISSOURI DEPARTMENT OF SOCIAL SERVICES |

| |DIVISION OF FAMILY SERVICES |

| |CONFIDENTIALITY AGREEMENT |

|All persons using or inquiring the Division of Family Services FAMIS must read and sign this confidentiality agreement that describes the many state and federal |

|laws and regulations that safeguard our client information. The specific laws governing the use of the information received are below. Laws apply regardless of how|

|we receive the information, i.e. from the client themselves, from a collateral, a document or a computer match, etc. Responsible handling of information dictates |

|not only “what” is shared and “to whom” but also “where”. Do not share information about clients over lunch, coffee breaks, in halls or elevators where others may |

|overhear names or identifying information. Remember each individual contributes to the collective professional reputation of an agency. |

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|You may be reprimanded, with a copy in your permanent file, suspended without pay or fired for violating these confidentiality laws and regulations. Violation of |

|some of the laws may result in misdemeanor or felony prosecution with penalties established by law upon conviction. If you have any questions ask your supervisor |

|for further information and clarification. You are given a copy of this confidentiality agreement to keep in your permanent records. We recommend you read through |

|the agreement periodically to keep it fresh in your mind. |

| |

|I have read and understand the following confidentiality laws. By signing this document I understand the penalties for violating the confidentiality of DFS clients|

|or other agency’s information. |

|NAME PRINTED |SIGNATURE |SSN |DATE |

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|Temporary Assistance for Needy Families and Medicaid |

|Temporary Assistance for Needy Families, Cash Programs & Medicaid - Missouri Revised State Statute 208.120.1. For the protection of applicants and recipients, all |

|officers and employees of the state of Missouri are prohibited, except as hereinafter provided, from disclosing any information obtained by them in the discharge |

|of their official dutites relative to the identity of applicants for or recipients of benefits or the contents of any records, files, papers, and communications, |

|except in proceedings or investigations where the eligibility of an applicant to receive benefits, or the amount received or to be received by any recipient, is |

|called into question, or for the purposes directly connected with the administration of public assistance. In any judicial proceedings, except such proceedings as |

|are directly concerned with the administration of these programs, such information obtained in the discharge of official duties relative to the identity of |

|applicants for or recipients of benefits, and records, files, papers, communications, and their contents shall be confidential and not admissible in evidence. |

|2....3. It shall be unlawful for any person, association, firm, corporation or other agency to solicit, disclose, receive, make use of or authorize, knowingly |

|permit, participate in or acquiesce in the use of any name or lists of names for commercial or political purposes of any nature; or for any name or list of names |

|of recipients secured from such report in the county welfare office to be published in any manner. Anyone willfully or knowingly violating any provisions of this |

|section shall be guilty of a misdemeanor. If the violation is by other than an individual, the penalty may be adjudged against any officer, agent, employee, |

|servant or other person of the association, firm, corporation or other agency who committed or participated in such violation and is found guilty. |

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|Temporary Assistance for Needy Families - Code of Federal Regulations (CFR) 45 ( 250.50 (a) (1) (v) State Plan Requirements. The State or local agency responsible |

|for the administration of the State plan has authority to disclose the current address of a recipient to a State or local law enforcement officer at his or her |

|request. Such information is disclosed only to law enforcement officers who provide the name and Social Security number of the reciepient and satisfactorily |

|demonstrate that: (A) the recipient is a fugitive felon....(B) The location or apprehension of such felon is within the law officer’s official duties; and (C) The |

|request is made in the proper exercise of those duties. |

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|(2) The agency will have clearly defined criteria which govern the types of information that are safeguarded and the conditions under which such information may be|

|released or used...(i) types of information to be safeguarded include but are not limited to: (A) The names and addresses of particular individual ...; (C) Agency |

|evaluation of information about a particular individual; (D) Medical data |

|(ii) The release or use of information concerning individuals applying for or concerning individuals applying for a receiving financial assistance is restricted to|

|persons or agency representatives who are subject to standards of confidentiality which are comparable to those of the agency administering the financial |

|assistance programs. |

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|Medicaid CFR 42 Subpart F ( 431.306 and ( 431.307 (a) The agency must have criteria specifying the conditions for release and use of information about applicants |

|and recipients. (b) Access to information concerning applicants or recipients must be restricted to persons or agency representatives who are subject to standards |

|of confidentiality that are comparable to those of the agency (c) The agency must not publish names of applicants or recipients (d) The agency must obtain |

|permission from a family or individual, ...before resonding to a request for information from an outside source...431.307 (a) All materials distributed to |

|applicants, recipients, or medical providers must (1) Directly relate to the administration of the Medicaid program... |

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|Food Stamps |

|Part 272.1 (c)(1)(i) through (3) Disclosures. (1) Use or disclosure of information obtained from food stamp applicant or recipient households shall be restricted |

|to: (I) Persons directly connected with the administration or enforcement of the provisions of the Food Stamp Act or regulations, other Federal assistance |

|programs, federally-assisted State programs providing assistance on a means-tested basis to low income individuals, or general assistance programs which are |

|subject to the joint processing requirements...(ii)...(iii) Persons directly connected with the verification of immigration status of aliens applying for food |

|stamp benefits through .. SAVE programs to the extent, the information is necessary to identify the individual for verification purposes. (iv) Persons directly |

|connected with the administration of the Child Support Program under Part D, Title IV of the Social Security Act in order to assist in the administration of that |

|program,...(v) Employees of the Comptroller General’s Office of the US for audit examination authorized by any other provision of law and (vi) Local, State or |

|Federal law enforcement officials, upon their written request for the purpose of investigation an alleged violation of the Food Stamp Act or regulation. The |

|written request shall include the identity of the individual requesting the information and his authority to do so, violation being investigated and the identity |

|of the person on whom the information is requested.... |

|(3) If there is a written request by a responsible member of the household, its currently authorized representative, or a person acting on its behalf to review |

|material and information contained in its casefile, the material and information contained in the casefile shall be made available for inspection during normal |

|business hours.... |

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|Internal Revenue Service -- A computer match is completed with the IRS for unearned income information. Information displayed on a computer screen received from |

|the match or any form/notice produced as a result of the match are included in the following Internal Revenue Code (IRC) and the 1997 Taxpayer Browsing Protection |

|Act. |

|MO 886-3729 (7-99)/E |DISTRIBUTION: WHITE - DFS PERSONNEL OFFICER CANARY - COUNTY FILE PINK - WORKER |FA 700 |

|01-2002 | | |

|IRC Section 7213 (a) states the unauthorized disclosure of Federal tax return information is a felony punishable by a $5000 fine, up to five years imprisonment or |

|both, together with the costs of prosecution. |

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|IRC Section 7431 permits a taxpayer to bring suit against individual staff for civil and punitive damage in U.S. District Court for willful disclosure or gross |

|negligence for unauthorized disclosures even after DFS employment terminates. |

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|IRC Section 6103 prohibits a person from willfully disclosing any return information except as authorized by Title 26 or the United States Code |

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|The 1997 Taxpayer Browsing Protection Act provides a penalty for the willful, unauthorized access or inspection of federal tax informatio, both electronic and |

|paper formats. Upon conviction, the criminal misdemeanor penalty is a fine of up to $1000 and/or imprisonment up to one year. Civil damages for each finding of |

|liability are up to $1000 or actual damages whichever is greater. If gross negligence or willful unauthorized inspection or disclosure, punitive damages may be |

|assessed. |

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|IRC Section 2651 requires that Social Security information from computer matches be treated the same as IRS data (26 U.S.C. 6103) |

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|Unemployment Insurance and Wage information used by States -- Information received from the computer match with the Division of Employment Security files may only |

|be used to administer DFS programs and may not shared with other persons. You may not access the information of any person not requesting benefits from a DFS |

|program or other clients that are not assigned to your workload, including your own information. |

| |

|20 CFR 603.7 Protection of confidentiality. (a) State unemployment compensation agencies shall require requesting agencies receiving information under this part to|

|comply with the following measures to protect the confidentiality of the information against unauthorized access or disclosure: (1) The information shall be used |

|only to the extent necessary to assist in the valid administrative needs of the program receiving such information and shall be disclosed only for these purposes |

|as defined in this agreement: (2) ... (3) The information shall be stored in a place physically secure from access by unauthorized persons; (4) Information in |

|electronic format, ..., shall be stored and processed in such a way that unauthorized persons cannot retrieve the information by means of computer, remote terminal|

|or other means; (5) Precautions shall be taken to ensure that only authorized personnel are given access to on-line files; (6) (I) The requesting agency shall |

|instruct all personnel with access to the information regarding the confidential nature of the information, the requirements of this part, and the sanctions |

|specified in State unemployement compensation laws against unauthorized disclosure of information covered by this part, and any other relevant state statutes, and |

|... |

|(b) Any requesting agency is authorized to redisclose the information only as follows: (1) Any wage or claim information may be given to the individual who is the |

|subject of the information; (2) Information about an individual may be given to an attorney or other duly authorized agent representing the individual if the |

|individual has given written consent and the information is needed in connection with a claim for benefits against the requesting agency (3) Any wage or claim |

|information may be given to antother requesting agency as defined in this part or to any criminal or civil prosecuting authorities acting for or on behalf of the |

|requesting agency... |

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|Division of Child Support Enforcement |

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|CRF 45 Ch.III ( 303.21 (a) (1) thru (3) and (b) Safeguarding information. (a) Under State statute which imposes legal sanctions, the use or disclosure of |

|information concerning applicants or recipients of support enforcement services is limited to purposes directly connected with: (1) The administration of the plan |

|or program approved under parts A, B, D, E or R of title IV or under titles I, X, XIV, XIX or XX or supplemental security income program established under title |

|XVI; (2) Any investigations, prosecution or criminal or civil proceeding conducted in connection with the administration of any such plan or program; (3) The |

|administration of any other Federal or Federaly assisted program which provides assistance, in cash or in kind, or services, directly to individuals on the basis |

|of need: ..(b) These safeguards shall also prohibit disclosures to any committee or legislative body (Federal, State, or local) of any information that identifies |

|by name or address any such applicant or recipient. |

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|Missouri State Children’s Services Law |

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|State Statute 210.150 Confidentiality of reports and records, exceptions-violations, penalty. 1. The division of family services shall ensure the confidentiality |

|of all reports and records made pursuant to sections 210.109 to 210.183 and maintained by the division, its local offices, .... To protect the rights of the family|

|and the child named in the report as a victim, the Division of Family Services shall establish guidelines which will ensure that any disclosure of information |

|concerning the abuse and neglect involving that child is made only to persons or agencies that have a right to such information. |

|3. Only the following persons shall have access to records maintained by the division pursuant to section 210.152 for which the division has received a report of |

|child abuse and neglect and which the division has determined that there is insufficient evidence or in which the division proceeded with the family assessment and|

|services approach: (1) Appropriate staff of the division...... |

|5. Any person who knowingly violates the provisions of this section, or who permits or encourages the unauthorized dissemination of information contained in the |

|information system or the nautre of information contained in the information system or the central registry and in reports and records made pursuant to sections |

|210.109 to 210.183, shall be guilty of a class A misdemeanor. |

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|Department of Mental Health |

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|State Statute 630.140 Records confidential, when-may be disclosed, to whom, how, when-release to be documented . . 1. Information and records compiled, obtained, |

|prepared or maintained by the residential facility or day program operated, funded or licensed by the department or otherwise in the course of providing services |

|to either voluntary or involuntary patients, residents or clients shall be confidential. 2 ...3. The facilities or services may disclose information and records |

|under any of the following: (1) As authorized by the patient, resident or client; (2) To persons or agencies reponsible for providing health care services to such |

|patients, residents or clients; (3) To the extent necessary for a recipient to make a claim or for a claim to be made on behalf of a recipient for aid or |

|insurance; ... 4. The facility or program shall document the dates, nature, purposes and recipients of any records disclosed under this section and sections |

|630.145 and 630.150.5 ... |

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|Social Security Administration |

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|Social Security Act Section 1137 (1) Data provided by SSA shall not be redisclosed or used for any purpose other than to determine eligibility for, or the amount |

|of, benefits under a State-administered health/income maintenance program required by law. Such state administered programs must be described in statements of |

|routine use published by SSA in the Federal Register or otherwise specifically approved by SSA. The State Agency may, however, disclose the information provided |

|with the consent of the subject individual as provided in the BENDEX handbook. (2) ... |

|(3) That files provided by SSA, and the information contained therein, will not be duplicated or disseminated within or outside the State Agency without the |

|written approval of SSA. |

|NAME PRINTED |SIGNATURE |SSN |DATE |

|MO 886-3729 (7-99)/E | |FA 700 |

|01-2002 | | |

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